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Apolipoprotein CIII and stroke risk

According to this analysis from the Verona Heart Study, elevated plasma levels of apolipoprotein CIII (apoCIII) confer an increased risk of acute ischaemic cerebrovascular events (stroke and transient ischaemic attack, TIA).
The Verona Heart Study aims to identify new risk factors for coronary artery disease (CAD) in individuals undergoing coronary angiography. The current analysis included data from 950 people (median age 65 years, 31% female) with (n=774) and without (n=176) angiographically defined CAD. The primary endpoint was acute nonfatal ischaemic cerebrovascular events (ischaemic stroke or TIA). After a median follow-up of 130 months (interquartile range, 69–189 months), 95 (10%) individuals had a primary endpoint. These individuals also had higher plasma levels of apoCIII at entry to the study compared with those who did not experience a stroke/TIA (11.4; interquartile range: 9.3–14.4 mg/dL versus 8.7–13.0 mg/dL). Moreover, individuals with apoCIII levels above the median (>10.6 mg/dL) had a 2-fold increased risk of future stroke/TIA, which persisted even after adjustment for potential confounders including sex, age, hypertension, atrial fibrillation, oral anticoagulant treatment, and plasma lipids. The authors suggest that this association might be mediated by enhancement of the coagulation cascade and thrombin generation due to elevated apoCIII levels. However, they acknowledge that further study is needed to establish whether measurement of apoCIII plasma levels has a potential role in patient management in routine practice.
Increased incidence of ischemic cerebrovascular events in cardiovascular patients with elevated apolipoprotein CIII.

Olivieri O, Cappellari M, Turcato G et al